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Tongue Carcinoma

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1641. Mastitis and breast abscess

breast pain that are not associated with lactation include: Breast cancer — this includes ductal cancer (characterized by breast pain and/or bloody discharge), inflammatory breast cancer (characterized by rapid onset of warmth of the breast, diffuse redness, and oedema causing an orange skin [peau d'orange] appearance), and Paget's disease of the nipple (characterized by an itchy, red rash on the nipple, burning sensation in the breast, and bleeding from the nipple). For more information, see the CKS (...) central/subareolar or peripheral. Central/subareolar infection is usually secondary to periductal mastitis (a condition where the subareolar ducts are damaged and become infected). Peripheral infection (less common) is associated with diabetes mellitus, rheumatoid arthritis, trauma, corticosteroid treatment, and granulomatous lobular mastitis (a rare inflammatory disease of the breast), but often there is no underlying cause. The most common organisms associated with infectious mastitis in non

2018 NICE Clinical Knowledge Summaries

1642. Bacterial vaginosis

and gonorrhoea, a 9-fold risk of trichomoniasis, and a 2-fold risk of herpes simplex virus (HSV)-1 compared with women without BV [ ]. A prospective study of women with clinically suspected pelvic inflammatory disease (PID) reported significant association between the presence of BV-associated bacteria and the presence of endometritis and recurrent PID [ ; ]. BV is also associated with several obstetric and gynaecologic complications, including [ ; ; ; ; ; ] : Late miscarriage. Pre-term labour and delivery (...) notification (if necessary). Palpate the abdomen (if appropriate) to assess for tenderness or a mass (which may indicate malignancy). Inspect the vulva for lesions, discharge, vulvitis, ulcers, and any other changes. Perform a speculum examination (except in a pregnant woman with a low-lying placenta) to visualize the cervix and vagina to look for characteristic signs of BV. BV is characterized by a thin, white/grey, homogeneous coating of the vaginal walls and vulva that has a fishy odour

2018 NICE Clinical Knowledge Summaries

1643. Nausea/vomiting in pregnancy

examination. Goitre. Conditions causing nausea and vomiting in pregnancy: Genito-urinary conditions — urinary tract infection, uraemia, pyelonephritis, ovarian torsion, renal stones. Metabolic disorders and endocrine conditions — hypercalcaemia, thyrotoxicosis, diabetic ketoacidosis, Addison's disease. Gastrointestinal conditions — gastritis, gastroenteritis, peptic ulcer, pancreatitis, cholecystitis, bowel obstruction, hepatitis, cholelithiasis, appendicitis. Neurological disorders — vestibular disease (...) , migraine, central nervous system tumours. Other pregnancy-related conditions — acute fatty liver of pregnancy, pre-eclampsia. Drug-induced vomiting — for example iron or opioids. Psychological disorders — for example eating disorders. Basis for recommendation Basis for recommendation Findings suggesting an alternative diagnosis This information is based on a Royal College of Obstetricians and Gynaecologists (RCOG) guideline: The management of nausea and vomiting of pregnancy and hyperemesis gravidarum

2018 NICE Clinical Knowledge Summaries

1644. Dyspepsia - proven functional

. pylori re-testing. Consider offering re-testing for H. pylori , using clinical judgement, if: There has been poor compliance to first-line eradication therapy, or the initial test was performed within 2 weeks of proton pump inhibitor (PPI) or 4 weeks of antibiotic therapy. Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) is indicated, especially if there is a history of peptic ulcer disease. See the CKS topic on for more information. There is a family history of gastric malignancy (...) of malignancy or peptic ulcer disease, a maintenance PPI may be appropriate. This is supported by a subsequent Cochrane systematic review of 23 randomized controlled trials (RCTs, n = 8759) of the use of PPIs for functional dyspepsia, which found moderate-quality evidence that 2–8 weeks of PPI therapy was slightly more effective than placebo at relieving functional dyspepsia symptoms. It also found low-quality evidence that PPIs may be slightly more effective than H 2 RAs at relieving symptoms. Low-dose

2018 NICE Clinical Knowledge Summaries

1645. Anaemia - iron deficiency

causes include oesophagitis, schistosomiasis or hookworm, or inflammatory bowel disease. Increased loss — chronic blood loss, especially from the uterus or gastrointestinal tract (GI). In adult men and postmenopausal women, GI blood loss is the most common cause of iron deficiency anaemia. It can be caused by aspirin or nonsteroidal anti-inflammatory drug use, colonic carcinoma, gastric carcinoma, benign gastric ulceration, or angiodysplasia. Menstruation is the most common cause of iron deficiency (...) 15 micrograms/L confirms the diagnosis of iron deficiency. Ferritin levels of more than 15 micrograms/L are more difficult to interpret if infection or inflammation is present, as levels can be high even in the presence of iron deficiency. Ferritin levels are increased independently of iron status in acute and chronic inflammatory conditions, malignant disease and liver disease. Expert opinion varies as to the level of ferritin which is diagnostic of iron deficiency anaemia in people with chronic

2018 NICE Clinical Knowledge Summaries

1646. Dyspepsia - proven peptic ulcer

NSAIDs are offered full-dose PPI or H 2 RA for 4–8 weeks. Audit criterion 15. People with previous peptic ulcer for whom continuation of NSAID is necessary and are receiving a NSAID are prescribed a PPI. Audit criterion 16. In people with an unhealed peptic ulcer, the following are excluded: Non-adherence. Malignancy. Failure to detect H. pylori . Inadvertent NSAID use. Other ulcer-inducing medication. Rare causes such as Zollinger-Ellison syndrome or Crohn's disease. Audit criterion 17. If symptoms (...) What are the risk factors? Risk factors for the development of peptic ulcer disease include [ ; ; ; ] : Helicobacter pylori infection — 95% of duodenal and 70–80% of gastric ulcers are associated with H. pylori infection. Infection causes increased gastric acid secretion in some cases, which increases the risk of mucosal ulceration. In other cases, gastric acid secretion is decreased causing chronic atrophic gastritis, which increases the risk of gastric ulceration and possible gastric malignancy

2018 NICE Clinical Knowledge Summaries

1647. Dyspepsia - unidentified cause

been extrapolated from expert opinion in the World Gastroenterology Organisation (WGO) guideline Global perspective on gastroesophageal reflux disease [ ]. The recommendation on considering checking a full blood count to look for anaemia and/or a raised platelet count is based on the NICE clinical guideline Suspected cancer: recognition and referral [ ], and is supported by expert opinion in a US review article on dyspepsia [ ]. Unexplained iron deficiency anaemia or a raised platelet count can (...) be an indicator of upper gastrointestinal malignancy, particularly if associated with symptoms of upper abdominal pain, dyspepsia, reflux, weight loss, nausea and/or vomiting [ ]. Differential diagnosis What else might it be? Other conditions which may also present with dyspepsia symptoms include: Upper gastrointestinal malignancy — see the CKS topic on for more information. Gallbladder or hepatobiliary disease — see the CKS topics on , , and for more information. Pancreatic disease — see the CKS topics

2018 NICE Clinical Knowledge Summaries

1648. Palliative care - oral

. Diet: such as garlic, onions, alcohol. Perceived halitosis (the person experiences halitosis but it cannot be detected by others). [ ; ; ; ] Alteration in taste Alteration in taste Factors causing alteration in taste include: Local disease of the mouth and tongue caused by cancer. Local surgery (elimination of the olfactory component of taste after laryngectomy, or surgical removal of the tongue or palate). Alteration of the cell-renewal or cell-regenerating cycle (for example due to malnutrition (...) painful. Malignant oral ulcers Many oral cancers (e.g. lip, tongue, gingiva, buccal mucosa, floor of the mouth) ulcerate. A typical malignant ulcer is hard, with heaped-up and often everted or rolled edges and a granular floor. Basis for recommendation Basis for recommendation Examination This recommendation is based on expert opinion in a review article [ ]. Clinical features of candidal infection This recommendation is based on expert opinion in textbooks and a review article

2018 NICE Clinical Knowledge Summaries

1649. Scarlet fever

. Kawasaki disease may present with a red rash and strawberry tongue. It often causes cervical lymphadenopathy, fever, conjunctivitis and skin peeling or swelling of the hands. Staphylococcal toxic shock syndrome (TSS) is a potentially life-threatening condition. Symptoms may include fever, headache, skin rash, confusion, vomiting or diarrhoea and may progress to shock and death. Risk factors include tampon use, the postpartum period, staphylococcal skin or soft tissue infections and influenza. Rare (...) Scarlet fever Scarlet fever - NICE CKS Share Scarlet fever: Summary Scarlet fever is a notifiable infectious disease caused by toxin-producing strains of the group A streptococcus bacterium ( Streptococcus pyogenes ). The bacteria are spread when the person's mouth, throat, or nose comes into contact with infected saliva or mucus (which may be present on cups, utensils, and surfaces), or by aerosol transmission. Outbreaks in schools or other institutions sometimes occur. Once a person has had

2018 NICE Clinical Knowledge Summaries

1650. Dental abscess

in the mouth. Fever and malaise. Trismus (inability to open the mouth) or dysphagia. Signs of dental abscess include: Facial swelling. Regional lymphadenopathy. An elevated or decayed tooth, with increased mobility and tenderness. Gum swelling, with tenderness, warmth, and a purulent exudate. Differential diagnoses include: infections (such as mumps, sinusitis, acute otitis media, or facial cellulitis); salivary gland problems; neoplasm; and unerupted teeth. Definitive treatment for a dental abscess should (...) reported as 5–46% [ ]. Risk factors What are the risk factors? Risk factors for dental abscess include: Poor oral hygiene. Dental caries. Periodontal disease. Dental trauma. Partially erupted or impacted tooth. Alcohol or drug misuse. Malnutrition. Immunocompromise. History of radiotherapy. Medications causing dry mouth (for example antihistamines, anticholinergics, antidepressants). [ ] Complications What are the complications? Complications of dental abscess include: Loss of the affected tooth

2018 NICE Clinical Knowledge Summaries

1651. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC (...) business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC, Canada Tyler Hughes, M.D. McPherson Hospital McPherson

2016 Effective Health Care Program (AHRQ)

1652. Acne clinical guideline Full Text available with Trip Pro

and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence. Key words: , , , , , , , , , , , , , , , , , , , , , , , , , , Disclaimer Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be interpreted (...) as setting a standard of care, or be deemed inclusive of all proper methods of care, nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy or technique must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the disease. This guideline reflects the best available data at the time

2016 American Academy of Dermatology

1653. Persistent Pain with Breastfeeding

(topical), chamo- mile, vitamins A and E, and fragrances. 18,20 (III) 2. Psoriasis Flarescanoccurduringlactationsporadically(usually 4–6 weeks after the birth 21 (III) or as a response to skin injury (koebnerization) from latch, suckling, or biting. 3. Mammary Paget’s disease (Paget’s disease of the nipple) More common in postmenopausal women (60–80% of cases), but observed in younger women, this slow- growing intraductal carcinoma mimics eczema of the nipple. A unilateral, slowly advancing nipple (...) ,suboptimalpositioning ofthe infantduringa breastfeed can lead to a shallow latchandabnormalcompressionofthenipplebetween the tongue and palate. 9–11 (II-2, III, III) B Disorganized or dysfunctional latch/suck: The abil- ity of an infant to properly latch and breastfeed is dependent, among otherfactors, onprematurity, oral and mandibular anatomy, muscle tone, neurological maturity, and re?ux or congenital abnormities, as well as maternal issues such as milk ?ow, breast/ nipple size, and engorgement. Infants who

2016 Academy of Breastfeeding Medicine

1654. Recovery: care of the child/young person

( ) ( ). Common causes of airway obstruction include: tongue ( ) laryngospasm ( ) foreign bodies such as vomit, acidic gastric contents, mucous, blood/secretions and dislodged teeth Determine the need for techniques to open the airway and the continued use/insertion of airway adjuncts until the child begins to regain consciousness: Manual techniques: chin tilt: neutral position for neonates, ‘sniffing the morning air’ for small child. jaw thrust for adolescents/adults Airway adjuncts: ( ) nasopharyngeal (...) by blue hands, feet and fingernail beds ( ). Central cyanosis: indicated by blue lips, tongue and mucous membranes ( ). An anaemic child may not appear cyanotic despite the presence of profound hypoxaemia ( ). Note oxygen saturation readings and maintain oxygen therapy (40 % - 100 %) to ensure oxygen saturation remain above 94%. The duration of oxygen therapy should be determined by the oxygen saturation values in the recovery unit ( ). If required, provide ventilatory support as necessary

2015 Publication 1593

1655. Establishing breastfeeding

infections 8 16 RR: 0.68 0.60–0.77 reduced Mortality due to infectious diseases 8 9 OR: 0.48 0.38–0.60 reduced Protection against diarrhoea morbidity/hospital admission 8 15 RR: 0.69 0.58–0.82 reduced Maternal Breast cancer 21 98 OR: 0.78 0.74–0.82 reduced Ovarian cancer 21 41 OR: 0.70 0.64–0.77 reduced Type 2 diabetes 22 6 RR: 0.68 0.57–0.82 reduced BMI in postmenopausal women 23 1 0.22 kg/m 2 0.21–0.22 reduced CI: Confidence Interval; OR: Odds Ratio; RR Relative Risk, BMI: Body Mass Index. See (...) definitions for explanation of OR Queensland Clinical Guideline: Establishing breastfeeding Refer to online version, destroy printed copies after use Page 7 of 28 1.2 Breastfeeding cautions In Australia, there are very few indications for completely avoiding breastfeeding. 2 Individualise care and seek expert advice as required. Table 2. Breastfeeding cautions Aspect Consideration Breastfeeding not recommended • Specialised formula required for: o Galactosaemia o Maple syrup urine disease o

2016 Clinical Practice Guidelines Portal

1656. Establishing breastfeeding

infections 8 16 RR: 0.68 0.60–0.77 reduced Mortality due to infectious diseases 8 9 OR: 0.48 0.38–0.60 reduced Protection against diarrhoea morbidity/hospital admission 8 15 RR: 0.69 0.58–0.82 reduced Maternal Breast cancer 21 98 OR: 0.78 0.74–0.82 reduced Ovarian cancer 21 41 OR: 0.70 0.64–0.77 reduced Type 2 diabetes 22 6 RR: 0.68 0.57–0.82 reduced BMI in postmenopausal women 23 1 0.22 kg/m 2 0.21–0.22 reduced CI: Confidence Interval; OR: Odds Ratio; RR Relative Risk, BMI: Body Mass Index. See (...) definitions for explanation of OR Queensland Clinical Guideline: Establishing breastfeeding Refer to online version, destroy printed copies after use Page 7 of 28 1.2 Breastfeeding cautions In Australia, there are very few indications for completely avoiding breastfeeding. 2 Individualise care and seek expert advice as required. Table 2. Breastfeeding cautions Aspect Consideration Breastfeeding not recommended • Specialised formula required for: o Galactosaemia o Maple syrup urine disease o

2016 Queensland Health

1657. The Management of Diabetic Foot Full Text available with Trip Pro

-brachial index; DFU, diabetic foot ulcer; HBO, hyperbaric oxygen; MRI, magnetic resonance imaging; NPWT, negative pressure wound therapy; PAD, peripheral arterial disease; PTB, probe to bone; TcP o 2 , transcutaneous oxygen pressure; XR, radiography. Hide Pane Expand all Collapse all Article Outline Background Diabetes mellitus continues to grow in global prevalence and to consume an increasing amount of health care resources. One of the key areas of morbidity associated with diabetes is the diabetic (...) of the literature. Specific areas of focus included (1) prevention of diabetic foot ulceration, (2) off-loading, (3) diagnosis of osteomyelitis, (4) wound care, and (5) peripheral arterial disease. Results Although we identified only limited high-quality evidence for many of the critical questions, we used the best available evidence and considered the patients' values and preferences and the clinical context to develop these guidelines. We include preventive recommendations such as those for adequate glycemic

2016 Society for Vascular Surgery

1658. Barrett's Esophagus

). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity (3), and age over 50 years (4, 5). The goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s (6, 7). The purpose of this guideline is to review the definition and epidemiology of BE, available screening modalities for BE detection, rationale (...) both effective and well tolerated (strong recommendation, moderate level of evidence). In patients with T1b EAC, consultation with multidisciplinary surgical oncology team should occur before embarking on endoscopic therapy. In such patients, endoscopic therapy may be an alternative strategy to esophagectomy, especially in those with superficial (sm1) disease with a well-differentiated neoplasm lacking lymphovascular invasion, as well as those who are poor surgical candidates (strong recommendation

2016 American Gastroenterological Association Institute

1659. Male Urethral Stricture

Male Urethral Stricture Urethral Stricture Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep (...) who require chronic self-catheterization (e.g. neurogenic bladder), surgeons may offer urethroplasty as a treatment option for urethral stricture causing difficulty with intermittent self-catheterization. (Expert Opinion) 30. Clinicians may perform biopsy for suspected lichen sclerosus (LS), and must perform biopsy if urethral cancer is suspected. (Clinical Principle) 31. In lichen sclerosus (LS) proven urethral stricture, surgeons should not use genital skin for reconstruction. (Strong

2016 American Urological Association

1660. Assessing Fitness to Drive

to relevant medical systems/diseases. The medical requirements for unconditional and conditional licences are summarised in a tabulated to differentiate between the requirements for private and commercial vehicle drivers. Additional information, including the rationale for the standards, as well as a general assessment and management considerations, is provided in the supporting text of each chapter. 5 Part A: 1 About this publication Assessing Fitness to Drive 2016 Part C comprises further supporting (...) • endurance/fatigue and vigilance demands associated with long periods spent on the road. 2.2 Medical conditions and driving 2.2.1 Conditions likely to affect driving Given the many causal factors in motor vehicle crashes, the extent to which medical conditions contribute to vehicle crashes is difficult to assess. There is, however, recognition of the potential for certain conditions to cause serious impairments. Examples of such conditions include: • blackouts • cardiovascular disease • diabetes

2016 Cardiac Society of Australia and New Zealand

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